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Blowout fracture-associated orbital cellulitis progressing to panophthalmitis: a case report
Atsuhide Takesue1, Yosuke Asada2, Hiroki Ooya2
1Department of Ophthalmology, Juntendo Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo, 177-8521, Japan. a.takesue@juntendo-nerima.jp.
Background:
Parvimonas micra is known as a causative agent of chronic periodontal disease. This Gram-positive obligate anaerobic coccus was cultured from the ocular surface of blowout fracture-related orbital cellulitis progressing to panophthalmitis.
Case Presentation:
The patient was a woman in her fifties who had panic disorder and subsequently was a victim of domestic violence. These factors led to delayed consultation. At the initial visit to an ophthalmologist, the ocular surface of the right eye was covered with pus. Swelling of the upper and lower eyelids prevented the eyelid from closing and exophthalmos, severe corneal ulcer, panophthalmitis, and no light perception were observed. Head computed tomography revealed an old blowout fracture and chronic sinusitis with orbital cellulitis. P. micra were isolated from culture of pus samples from the sinus and from the ocular surface.
Conclusions:
There is a possibility that P. micra invaded the orbit via the fragile bony site and caused orbital cellulitis, severe corneal ulcer, and panophthalmitis that required enucleation. In cases of coexisting old blowout fracture and chronic sinusitis, the chronic sinusitis should be treated as quickly as possible.
Insights
Parvimonas micra, a bacteria causing periodontal disease, led to severe eye infection and vision loss in a patient with a history of domestic violence and a blowout fracture. Prompt treatment of chronic sinusitis is crucial in similar cases.
Area of Science:
- Ophthalmology
- Microbiology
- Infectious Diseases
Background:
- Parvimonas micra (P. micra) is recognized as a pathogen in chronic periodontal disease.
- This Gram-positive, anaerobic coccus was identified on the ocular surface of a patient with blowout fracture-related orbital cellulitis.
Observation:
- A woman in her fifties with a history of panic disorder and domestic violence presented with delayed consultation for severe right eye infection.
- Clinical examination revealed purulent ocular discharge, eyelid swelling, exophthalmos, a severe corneal ulcer, panophthalmitis, and no light perception.
- Head CT confirmed an old blowout fracture and chronic sinusitis complicated by orbital cellulitis.
Findings:
- P. micra was successfully cultured from both sinus pus and ocular surface samples.
- The bacterial infection likely originated from the chronic sinusitis and spread through the orbital fracture site.
- The severe infection resulted in panophthalmitis requiring enucleation.
Implications:
- P. micra can cause severe orbital infections, including panophthalmitis, following facial trauma and sinusitis.
- Early diagnosis and aggressive management of chronic sinusitis are critical in patients with orbital fractures to prevent vision-threatening complications.
- This case highlights the importance of considering P. micra in the differential diagnosis of severe orbital infections, especially in patients with predisposing factors.
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